Camps and Classes
I have read the Liability Waiver and agree with its terms:
Grade in 2016-2017 school year
Participant's Name
Email

----------------------------------------------------------------------------------------------------------------------------------------------------------------
If you prefer not to register online, please print the information below and include Camp/Class Fee made payable to Creativity Camp with application and waiver...
Send to :  1231 Abington Pike, Richmond, IN 47374 


Participant Information

Name: __________________________________________________

Birth Date: ______________

Address:_____________________________________

City:____________________________________ State: ____________________

Phone Number:  _____________________

Grade in School in next school year________________

Parents: ________________________________________

Email: __________________________________

Name of Camp/Class: ______________________________________________________________________


Date(s) of camp/Class:___________________________________________________________________




Medical Information:  List any information regarding participant's health, allergies, physical, and/or emotional status in order to best serve his/her needs.  Attach additional sheets if necessary.

_____________________________________________________________________________

_____________________________________________________________________________



Creativity Camp-Stained Glass- LIABILITY WAIVER FORM 

 

RELEASE AND WAIVER: As the participate or parent or legal guardian of the below child, who is a minor child under the age of eighteen (18) (hereinafter “my Child”), and in exchange for the benefits to be derived by my Child’s participation in this Activity, sponsored by Kristen Brunton, I hereby agree, on behalf of myself and my child, to the following: 

I hereby grant my permission for myself or my Child to participate in the Activity. I am aware of the risks and hazards connected with myself or my Child’s participation in the Activity, and hereby elect to allow myself or my  Child to voluntarily participate in the Activity, knowing that the Activity may be hazardous to myself or my Child or to his or her property. On behalf of myself and my Child, I VOLUNTARILY ASSUME ALL RESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY, that may be sustained by myself or my Child, or any loss or damage to property owned by myself or my Child, as a result of myself or my Child being engaged in the Activity, WHETHER CAUSED BY THE NEGLIGENCE OF THE ORGANIZATION OR ITS VOLUNTEERS, AGENTS, or otherwise. 

On behalf of myself and my Child, as well as our respective estates, heirs, administrators, executors, and assigns, I hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE Kristen Brunton, employees, or volunteers (hereinafter “RELEASEES”) from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, that may be sustained by me, or my Child, to any property belonging to me or my Child, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES or otherwise, while participating in the Activity. It is my express intent that this Release and Hold Harmless Agreement (hereinafter “Agreement”) shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE the above-named RELEASEES. I hereby further agree that this Agreement shall be construed in accordance with the laws of the State of Indiana. 

HEALTH CARE AUTHORIZATION: The undersigned hereby authorizes Kristen Brunton or volunteers to perform any acts which may be necessary or proper to provide emergency health care of any student in the event that the parent/guardian and/or emergency contact cannot be reached, including consent to and authorization of medical procedures by qualified, licensed physicians, dentists, hospital or other emergency medical personnel, as they, in the exercise of their profession and in their sole discretion, may deem necessary. The undersigned understands that (s)he is responsible for all costs and expenses of such medical treatment. 

In signing this agreement, I acknowledge and represent that I have read and understand it; that I sign it voluntarily and for full and adequate consideration, fully intending to be bound by the same; and that I am at least eighteen (18) years of age, fully competent, and the legal parent or guardian of my Child. 

I give permission to photograph myself or my child for marketing purposes such as promotion of future Creativity Camps or classes provided by Kristen Brunton. 

 

Participant’s Printed Name_____________________________________________________________ 

Parent’s Printed Name(if child above) ____________________________________________________________ 

Signature________________________________________________________________________ Date________________________________

Thanks to the following scholarship providers for Summer 2015

  • ​Mark Brunton Jr.- Better Homes & Gardens First Realty Group
  • Carole & Allen Brady
  • Diane & Eric Schmidt

​If you would like to provide a scholarship for a child, please select Register for Camps and select make a donation.  Thank You!

Register for Camps and Classes